Increased prevalence of osteopenia and osteoporosis in systemic sclerosis patients, including in men and young women—a case–control study

Abstract

Objectives: To investigate bone mineral density (BMD), osteoporosis prevalence and SSc-specific associations of BMD in SSc patients compared with background population. Methods: In total, 211 SSc patients (182 women, 29 men; mean age 61.3 and 62.2 years, respectively) and 505 age- and sex-matched controls from the same geographic area participated. BMD and T-score at total hip and lumbar spine was measured by dual-energy X-ray absorptiometry. Osteopenia was defined as T-score –1.0 to –2.5, and osteoporosis as T-score ≤–2.5. Associates of low BMD were identified by multiple regression analysis. Results: Women with SSc had lower BMD for total hip (P < 0.001) and spine (P = 0.011), equivalent to ΔT-score –0.56 and –0.35 compared with controls. Osteopenia was present in 51.6% and 16.5% had osteoporosis (P = 0.001, compared with controls). Already in women below age 45 years, differences in hip BMD were apparent (ΔT-score –0.93, P = 0.005). In addition to expected risk factors for osteoporosis (older age, lower BMI and menopause), finger ulcers (P = 0.009) and diffuse skin involvement (P = 0.027) were associated with lower hip BMD in women. In men with SSc, more than half displayed osteopenia or osteoporosis and had numerically lower hip BMD than their age-matched counterparts. Conclusion: SSc patients, including men and younger women, have lower BMD than the background population. Finger ulcers and diffuse skin involvement, in addition to older age, lower BMI and being post-menopausal, are associated with lower BMD in women. The data emphasize the importance of performing bone health assessment of all SSc patients, including men and young subjects.